HAKIM RESEARCH JOURNAL
Year:2008 | Volume:11 | Issue:3|Papers Count:11

Introduction: Integration of health services and medical education - the brief manifest of Iran’s Ministry of Health and Medical Education (MOHME) - has been studied mainly from the perspective of health service and medical education quality so far. The objective of present study however, is to examine the impact of integrated structure of MOHME on domestic research utilization. Macro-level policy makers in charge of designing the national research and innovation system are expected to benefit from the results of this study.Methods: The study was conducted in form of Grounded Theory and through interviews with a wide range of persons ranging from policy makers to healthcare providers in medical and non-medical groups.Results: ‘Integration’ has not fully evolved yet. Beyond the structural changes that have been created at the higher levels of MOHME and medical universities, a set of processes should have been defined for attainment of the desired goals. Neither the created structural changes have covered the level of educational and research groups, nor the set of needed processes has been defined. The issue of inadequate research utilization is not limited to health sector, but is also present in other pillars of the national research and innovation system.Conclusion: From the perspective of health research, the national research and innovation system should be defined at the macro level before making any decisions about changing the current structures. The reason is that the main problems of the research system in Iran are not confined to medical sciences or the ‘integration’, but more general and drastic issues are existent. Any putative structural changes in the ‘integration’ and medical sciences should be viewed only as secondary to these main issues.

Introduction: The objective of this study is to assess the medicines and materials dispensed by medicinal herbs sellers in Tehran for treatment of drug addiction.Methods: This study consisted of a qualitative study and a chemical laboratory analysis. In-depth interviews with a sample consisting of 52 medicinal herbs sellers from 22 zones of Tehran’s Municipality and 32 drug dependents or their family members were performed, and thin layer chromatography was done for 55 specimens from handmade anonymous materials sold by medicinal herbs sellers for treatment of addiction.Results: Eighty five percent of the studied herb sellers were active in treatment of addiction. The prescribed herbs consisted of Lavandula, Valerian, Citrus, Bishop’s weed fruit, and sweet balm. Although only 20% of the herb sellers disclosed dispensing chemical compounds as well as herbals, but all of the analyzed specimens included at least one chemical. Ninety one percent of the specimens contained diphenoxylate and 58% included at least one opioid. The cost of treatment ranged from 100 thousand to two million Iranian Rials per patient. Seventy five percent of addicts judged the dispensed medicines and material as either ineffective or addictive.Conclusion: Widespread and active involvement of herb sellers in prescription and selling of handmade chemical compounds for treatment of addiction, despite its illegality, and the large public demand for such medicines pose a serious challenge for the concerned policymakers. Scientific approach to herbal medicine, supervision of Ministry of Health and Medical Education on their production, licensing their sale, development and application of supervisory regulations, systematic training of those involved in production, prescription, and sale of herbal medicines, and public awareness rising are recommended.

Introduction: A large number of surgical and non-surgical treatment methods have been propounded for cystic echinococcosis of liver so far. For decades, surgical excision via conservative or radical approaches was the only known treatment method for this disease. Availability of chemotherapeutic agents with considerable activity against Echinococcus granulosus has made it possible to treat hydatid cysts with ultrasound- or computed tomography-guided transhepatic percutaneous drainage method, named Puncture, Aspiration, Injection, and Re-aspiration (PAIR). The aim of this study was to compare the older and newer treatment methods for liver hydatid cyst.Methods: A search was made on three decades later in four different data bases MEDLINE, Chohran Library, Web of Science and ScienceDirect with keywords: “hepatic hydatid cyst”,”Albendazol”,” Cystic echinococcosis”,”PAIR”, ”metaanalysis”, Randomized controlled trial”.Results: Three hundred and seven studies met our inclusion criteria. Most of these studies had considerably large-sized samples of patients with hepatic hydatid cyst. They were comprised of original research articles، case reports, review articles, and randomized controlled trials. These studies had assessed efficacy of conventional surgical methods as well as that of chemotherapy and PAIR.Conclusion: Surgery with different techniques aiming eradication and reduction of recurrence is considered as one the main treatment methods. However, use of percutaneous drainage and minimally invasive techniques is now growing. PAIR with albendazole appears to have higher clinical efficacy, and lower rates of major and minor complications, mortality, short and long term disease recurrence, and fewer days of hospitalization as compared with surgery. Therefore, it is preferable to surgery. Surgery is suggestible in cases for which PAIR is not feasible or complications of the cyst are an issue. Pre- and post-intervention chemotherapy reduces disease recurrence and intraperitoneal seeding of infection.

Introduction: A direct relationship exists between air temperature and seasonal and daily variations of mortality. Stressor effect of temperature decrease and increase has a significant increasing impact on death rate. Quantification of the relationship between daily mortality and air temperature is useful as a fundamental policy for accuracy enhancement of temperature decrease and increase warning system. The objective of this study was determination of the relationship between temperature and death rate and the Temperature Minimum Mortality (TMM) in Tehran during the period 2002-2005.Methods: In a descriptive and analytical study, we statistically analyzed the relationship between temperature and number of total deaths as well as deaths due to cardiovascular diseases, cerebrovascular accidents, and respiratory diseases. Studied population was the reference population for mortality in Tehran from which a 4-year sample of daily mortality was drawn for years 2000 to 2005.Results: Relationship between daily death numbers and daily temperature averages was V-shaped during the studied period. TMM for Tehran was calculated as 28.5°C. The more different the temperature was form the TMM, the more was the death rate. There was a strong and significant correlation between air temperature and mortality rate, especially with average monthly mortality rate. Determination coefficient was 0.76 with a 99% confidence level.Conclusion: The highest number of deaths had occurred in the cold months of the year (December, January, and February). The more decrease in temperature had occurred, the more had increased the mortality. Increase in cardiovascular diseases, cerebrovascular accidents, and respiratory diseases mortality rates during the cold months further clarifies this relationship. Amongst 22 zones of Tehran’s Municipality, zones 9, 6, and 12 had the highest death rates.

Introduction: General surgery residents are in chronic partial sleep deprivation during their training years at hospital. Chronic sleep deprivation adversely affects their mood, behavior, social relationship, learning ability, decision making, and patient care. Adverse effects of sleep deprivation on carefulness and precision, promptitude, hand skills, and dexterity of surgeons have been shown in different studies. The aim of present study was to estimate the degree of sleepiness among general surgery residents and obtaining their views about consequences of sleep deprivation and fatigue.Methods: This cross sectional study was performed on general surgery residents in Sina, Imam Khomeini, and Shariati Hospitals in Tehran, using a 38-item quantitative structured questionnaire. Epworth Sleepiness Scale (ESS) was used for assessment of sleepiness degree.Results: Forty eight general surgery residents were entered to the study. Average weekly work hours were 140-160 for first and second year residents and 100-120 for third and fourth year residents. Mean ESS score was 11.6 ± 0.69 (range, 3-21), which indicated moderate sleepiness. Twenty percent of residents were in the severe range of sleepiness. From the studied residents, 52.1% believed that sleep deprivation and fatigue had a major impact on their personal life, and 31.3% of them believed these factors had major impact on their work.Conclusion: Extended work hours, sleep deprivation, and fatigue lead to sleepiness of general surgery residents and this problem adversely affects their quality of life and performance. Based on the results of this study, revision and modification of general surgery residents' work hours are suggested.

Introduction: Road traffic crashes are the main cause of trauma mortality in most of world countries especially Iran. The objective of this study is to evaluate RTC mortality and morbidity in the last 10 years (1997-2006).Methods: Data were obtained from Iran official reports of police, health sources and the Statistical Centre of Iran (SCI). These data include population, registered motor-vehicles number, RTC, RTC injuries and deaths, during the period of 1997–2006. Statistical analysis was performed by Stata 8 software and significance of mortality change was evaluated by Poison distribution.Results: RTC fatalities increased between 22.1 (95%CI, 21.7-22.4) per 100,000 and 40.5 (95%CI, 40.1-41.0) per100,000 from 1997 to 2005, but in the last year of 2006, this trend is reversed and there was declined to 39.1 (95%CI, 38.7-39.6) per 100,000. RTC injuries has been increased from 110 to 401 per 100000 population from 1997 to 2005, but decreased to the 393 per 100000 in 2006.Conclusion: This paper shows road traffic crashes mortality and morbidity in Iran in recent ten years and the decrease in the last year. This decline was most probably the result of a variety of interventions, including legislation, police enforcement, improvements in traffic and transport, health care facilities and media and public education. It is recommended that efforts of all responsible organizations continue in unique leadership.

Introduction: Driving faults have always been a cause of traffic problems and accidents in all communities. Rates and types of the resultant traffic problems vary and depend on cultural, social, economic, and geographical contexts. Environmental factors, control measures, administrative issues, and disparity between transportation infrastructures and number of vehicles are among influencing factors on driving faults. However, the human causes are the main influencing factor and are responsible for the highest percentage of driving faults. The present study was designed to investigate the personality factors that may be related to driving behavior and faults in city of Shiraz in southwest Iran in 2005.Methods: Participants were recruited with convenient sampling in places like car services centers and one central specialty clinic. Questionnaires included a demographic one, Persian translation of Manchester Driver Behavior Questionnaire, and NEO FFI Personality Inventory. Analysis of variance and correlation analysis were used for analyzing data.Results: The findings showed significant positive correlation between neuroticism score and all types of driving faults (P<0.05). Negative and significant correlations were found between agreeableness and extraversion scores, and driving faults (P<0.05). No correlation was found between conscientiousness score and total driving faults. Positive correlation was observed between openness score, and non-violent faults (P<0.01). There were negative correlations between age and years of driving practice, and nonviolent driving faults. Surprisingly there was a significant positive correlation between years of formal education and all types of diving faults (P<0.05).Conclusion: The findings of the present study demonstrated a significant relationship between personality traits and driving faults. Therefore it is suggested to perform psychologic assessments at the time of granting driving licenses and periodically thereafter and provide trainings for fault-prone drivers.

Introduction: Considering the high prevalence of suicide in the 15-24 years old age group, a ground for preventive interventions can be laid out by identifying the youth with suicidal ideation. The present study aimed to assess the relative frequency of suicidal ideation in the students of three universities in city of Isfahan in central part of Iran.Methods: In a descriptive-analytic cross-sectional study, relative frequency of suicidal ideation was assessed among 300 students aged 19 to 25 years studying at three universities in Isfahan, namely University of Isfahan, Isfahan University of Medical Sciences, and Isfahan University of Technology in 2005. They were randomly selected proportional to size of male and female students in each university. We used World Health Organization’s standardized questionnaire for assessing mental health risk factors (STEP) comprised of demographic and suicidal ideation questions. Chi square test was used for data analysis using SPSS software.Results: Thirty one students (10.33%; 95% CI, 8.92%-11.07%) had suicidal ideation. Suicidal thoughts were significantly more frequent in male students of Isfahan University of Technology as compared with all other students (p < 0.05). Suicidal thoughts were also significantly more frequent in students residing in this university’s dormitories than its native students and also than students residing in other two universities’ dormitories (p < 0.05).Conclusion: Considering the relatively high frequency of suicidal thoughts especially in male nonnative students, a further prospective study with a larger sample size seems necessary to identify risk factors and at-risk groups more precisely, as well as to plan a stepwise program to reduce such identified risk factors.